WQ0031209_Sewer Extension_20070110

;ST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number:
(to be completed by DWQ)
1. Owner.
la. Town of Pembroke
Z
0
1b.
Full Legal Name (company, municipality, HOA, utility, etc.)
McDuffie Cummings Town Manager
Signing Official Name and Title (Please review 15A NCAC 2H
.0206(b) for authorized signing officials!)
1c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑
Private Partnership ❑ Corporation ❑ Other (specify):
0
1d.
PO Box 866
le. Pembroke
LL
Mailing Address
City
Z
1f.
NC
1g. 28372
Z
State
Zip Code
0
1 h.
[phone] 1 i. [phone]
1 j.
~
Telephone Facsimile
E-mail
0
2.
Project (Facility) Information:
J
2a.
Native Angels Homecare Agency, Inc.
2b. Robeson
a
Brief Project Name (permit will refer to this name)
County Where Project is Located
a
Q
3.
Contact Person. -
Q3a. Sam Powers Anderson Engineering and Associates PA
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone] 3c. soowersacarolina. net _
Phone Number E-mail
1. Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
phase, changing line size/length, etc.). Only include the modified information in this permit application - do not
duplicate project information in B(7) and B(10-11) that has already been included in the original permit.
2. Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
2a. If private, applicant will be. 2b. If sold, facilities owned by a (must choose one
El Retaining Ownership (i.e. store, church, single office, etc.) or ❑ Public Utility (Instruction 111)
Z ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
0 ❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
H 3. Town of Pembroke
Owner of Wastewater Treatment Facility (WWfF) Treating Wastewater From This Project
4a. Town of Pembroke WWTF 4b. NC-0027103
Name of 1AWfF VVWrF Permit No
PAY
TO THE
ORDER
OF
LUMBEE GUARANTY BANK 66-368 000795
TOWN OF PEMBROKE PEMBROKE, NORTH CAROLINA 531
THIS DISBURSEMENT HAS BEEN APPROVED
ACCOUNT PAYABLE FUND �AN 2G7 AS REQUIRED BY THE LOCAL GOVERNMENT
P.O. BOX 866 BUDGET AND FISCAL CONTROL ACT.
PEMBROKE, NC 28372 CHECK NO. CHECK DATE I VENDOR NO.
000795 12/28/2006 0000000197
*'FOUR HUNDRED AND XX/100 DOLLARS"'*''''"'"*"'*'*''"''**''** CHECK AMOUNT
NCDENR-DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699
$400.00
Mayor

t.-

FAS71`RACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
�pF W ATFRQ State of North Carolina
�O G Department of Environment and Natural Resources
Division of Water Quality
o FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included/addressed the following list of required application package items by
checking the space provided next to each applicable item. Failure to submit all required items will lead to your application
being returned as incomplete. This form may be photocopied for use as an original.
® I. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. Any changes to this form will result in the application being returned. The Division of Water Quality
(Division) will only accept application packages that have been fully completed with all applicable items
addressed. You do not need to submit detailed plans and specifications unless you respond NO to Item B(12)
® II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ 111. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension is permitted by a private applicant and will be serving residential or commercial lots (e.g.,
houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If the applicant is a
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch COLOR copy of the portion of a 7.5-minute USGS Topographic Map along
with this form. The map should identify the entire project area location as well as the closest downslope surface
waters as clearly as possible. Each map portion must be labeled with the map name and number, the identified
location of the sewer line and pump stations, and be of clear and reproducible quality. For instance, if the project
involves 4 miles of interceptor sewer that traverses over or near several different waterbodies (or counties,
basins, etc.), the map should have location ID's shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application.
❑ VII. Stream Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/peres or by contacting the appropriate regional
office.

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
❑ Vlll. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the PERCS
Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be accepted until a Finding of No
Significant Impact (FONSI) or Environmental Impact Statement (EIS) has been issued. A copy is to be submitted
with that permit application.
® IX. Certifications — Section D
The application must be certified by both the applicant and a North Carolina Registered Professional Engineer
(PE). The applicant signature must match the signing official listed in Item A(lb). The PE should NOT certify the
application if he/she is unfamiliar with 15A NCAC 2H .0200, the Gravity Sewer Minimum Design Criteria (most
recent version) and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
(most recent version), as applicable to the project. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
® X. Downstream Sewer & Wastewater Treatment Plant Capacity
The applicant has assured downstream pipe, pump station and treatment plant capacity. The addition of new
sources of wastewater from this project has been evaluated along the route to the receiving treatment plant. The
flow from this project will not cause capacity related sanitary sewer overflows or overburden any downstream
pump station en route to the receiving wastewater treatment plant. If the applicant is not the owner of the
downstream sewer or receiving treatment plant, submittal of flow acceptance letters) indicates that owner has
adequate capacity and will not violate G.S. 143-215.67(a).
THE COMPLETED FTA 02103 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell,
Swannanoa, North Carolina 28778
Cherokee, Clay, Graham, Haywood,
[phone]
Henderson, Jackson, Macon, Madison,
[phone] Fax
McDowell, Mitchell, Polk, Rutherford,
Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Hamett,
Fayetteville, North Carolina 28301
Hoke, Montgomery, Moore, Robeson,
[phone]
Richmond, Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue, Suite 301
Alexander, Cabarrus, Catawba,
Mooresville, North Carolina 28115
Cleveland, Gaston, Iredell, Lincoln,
[phone]
Mecklenburg, Rowan, Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance,
919 571-4718 Fax
Wake, Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan,
Washington, North Carolina 27889
Craven, Currituck, Dare, Gates, Greene,
[phone]
Hertford, Hyde, Jones, Lenoir, Martin,
[phone] Fax
Pamlico, Pasquotank, Perquimans, Pitt,
Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin,
Wilmington, North Carolina 28405
New Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Winston-Salem, North Carolina 27107
Davidson, Davie, Forsyth, Guilford,
[phone]
Rockingham, Randolph, Stokes, Surry,
[phone] Fax
Watauga, Wilkes, Yadkin
For more information, visit our web site at httpY1h2o.enrstate.nc.us/perml

• FAST -'RACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
1. Owner.
1 a. Town of Pembroke
1 b.
Application Number:
(to be completed by DWQ)
Full Legal Name (company, municipality, HOA, utility, etc.)
McDuffie Cummings, Town Manager
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
1 c.
The legal entity who will own this system is:
r--
❑ Individual ❑ Federal ® Municipality ❑ State/Cou
---- ------------- —
❑ Private
Partnersh❑ Corporation ❑ Other spec f_y):
1 d.
PO Box 866
1 e.
Pembroke
Mailing Address
City
1 f.
NC
1 g.
28372
State
Zip Code
1 h.
[phone] 11 [phone]
1j.
Telephone 1 Facsimile
E-mail
2.
Pn)je-d (Facility) Information:
2a.
Native Angels Homecare Agency, Inc.
2b.
Robeson
Brief Project Name (permit will refer to this name)
County Where Project is Located
3. Contact Person: _ _ _
3a. Sam Powers, Anderson Engineering and Associates, PA
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910) 671-9530 3c. spowersacan
Phone Number Email
1. Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
phase, changing line size/length, etc.). Only include the modified information in this permit application - do not
duplicate project information in B(7) and B(10-11) that has already been included in the original permit.
2. Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
2a. If private, applicant will be: 2b. If sold, facilities owned by a (must choose one
❑ Retaining Ownership (i.e. store, church, single office, etc.) or
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3. Town of Pembroke
❑ Public Utility (Instruction III)
❑ Homeowner Assoc./Developer (Instruction IV)
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
�a. Town of Pembroke WWTF 4b. NC-0027103
i Name of WWTF WWTF Permit No.
15a. Town of Pembroke 6b. 12' 0 ® Gravity c. unknown
Owner of Downstream Sewer eceiving Sewer Size Force Main Permit Number of Downstream Sewer (if known)
6. The origin of this wastewater is (check all that apply):
❑ Residential Subdivision ❑ Car Wash
❑ Apartments/Condominiums ❑ Institution 100 % Domestic/Commercial
❑ Mobile Home Park ❑ Hospital
❑ School ❑ Church
❑ Restaurant ❑ Nursing Home
® Office ❑ Other (specify): —
7. Volume of wastewater to be allocated for this particular project: 106,920 gallons per day
"Do not include previously permitted allocations
8- If the permitted flow is zero, indicate why:
❑ Interceptor Line - Flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected
% Industrial
% Other (specify):

FAST-tRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(I) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(I)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(1)(3).
148.5 DFU x 1 gpm/2 dfu = 74.25 gpm x 60 min/hr x 24 hr/day = 106,920 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
12" 0 1200
:s
220
Gravity or Force Main
(use the pull down menu)
Gravity
Gravity --
Z ENTER TOTAL LINE LENGTH IN MILES 0.27
V11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID Power Reliability Option— - -- —
(self chosen -as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
Q plans for cross-reference) �MGD) T GPMH portable generator w/telemet r; 4-wet well store e�
LL
Z--- ---- ----- ---
12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
w ❑ Yes ® No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
a variance is requested_ SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
m
13. Have the following
been submitted for
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Stormwater? ❑ Yes ❑ No ® WA
14. Does this project involve aerial lines or siphons? Check if yes: ❑
These lines_1(vitlhe_C9Osidered h_iclh_Driority and must, be checked onccemv-ery six months
15. Does this project have gravity sewer lines designed at minimum slopes?
Be aware that the Division will not accept installed lines more than 10% flatter than the minimum slope. Lines installed outside this tolerance should be
corrected prior to submitting the final engineering certification-

FAS?-'TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
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1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
® A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND,
❑ A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
option for any pump station near a Class C down slope waterbody.
Location ID on Map
(self chosen - as shown on Name of
map for cross-reference) Waterbody
Waterbody Stream Waterbody
County River Basin Index Classification
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
1. Applicant's Certification:
1, McDuffie Cummings, attest that this application for Native Anqels Homecare Agency Inc. has been reviewed by me
and is accurate and complete to the best of my knowledge. I understand that if all required parts of this application are
not completed and that if all required supporting documentation and attachments are not included, this application
package is subject to being returned as incomplete. Note: In accordance with North Carolina General Statutes 143-
215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any
application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10, 000 as well as civil
penalties up to $25,000 per viola
1 a.
Signing O Ign re 010
2. Professional Engineer's Certification:
zl- a
Date
I attest that this application for Native Angels Homecare Agency Inc has been reviewed by me and is accurate, complete
and consistent with the information in the engineering plans, calculations, and all other supporting documentation to the
best of my knowledge. I further attest that to the best of my knowledge the proposed design has been prepared in
accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February
12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June
1, 2000 and the watershed classification in accordance with Division guidance. Although certain portions of this submittal
package may have been developed by other professionals, inclusion of these materials under my signature and seal
signifies that I have reviewed this material and have judged it to be consistent with the proposed design. Note: In
accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
2a. Larry W. Anderson
Professional Engineer Name
2b. Anderson Engineering and Associates PA
Engineering Firm
2c. PO Box 1736
Mailing Address
2d. Lumberton 2e. NC 2f. 28359
City _ State Zip
2g. [phone] ;2h. [phone] 2i. andersonacarolinamet
Telephone i Facsimile E-mail
SEAL
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SUPPORTING CALCULATIONS FOR VARIANCE REQUEST
NATIVE ANGELS HOMECARE AGENCY, INC. SEWER EXTENSION
JANUARY 2007
At Flow = 106,920 gpd:
Given Input Data:
Shape ........................... Circular
Diameter ........................ 1.0000 ft
Flowrate ........................ 0.1700 cfs
Slope ........................... 0.0025 ft/ft
Manning's n ..................... 0.0130
Computed Results:
Depth ........................... 0.2087 ft
Area ............................ 0.7854 ft2
Wetted Area ..................... 0.1188 ft2
Wetted Perimeter ...... 0.9488 ft
Perimeter ....................... 3.1416 ft
Velocity ........................ 1.4306 fps
Hydraulic Radius ..............0.1252 ft
Percent Full .................... 20.8686 %
Full flow Flowrate ............1.7814 cfs
Full flow velocity .............2.2682 fps
To meet minimum design requirements of V = 2 fps and pipe flowing half full:
Given Input Data:
Shape ........................... Circular
Solving for ..................... Flowrate
Diameter ........................ 1.0000 ft
Depth ........................... 0.5000 ft
Slope ........................... 0.0025 ft/ft
Manning's n ..................... 0.0130
Computed Results:
Flowrate ........................ 0.8907 cfs
Area ............................ 0.7854 ft2
Wetted Area .................... 0.3927 ft2
Wetted Perimeter ............ 1.5708 ft
Perimeter ....................... 3.1416 ft
Velocity ........................ 2.2682 fps
Hydraulic Radius ............ 0.2500 ft
Percent Full .................... 50.0000 %
Full flow Flowrate ....... 1.7814 cfs
Full flow velocity .......... 2.2682 fps
Thus, flowrate must be 0.8907 cfs or 575,675 gpd.

Native Angels plans to construct a 460' x 240' gymnasium on site in a future phase of
construction (110400 square feet). Based on 15A NCAC 02T .0114, the average daily
flow would be
For Sports Centers => Gymnasiums, the average daily flow is 50 gal/ 100 sq. ft.
110,400 sq. ft. x 50 gal/ 100 sq. ft. = 55, 200 gpd
Also, Native Angels has an additional 13 acres on site on which it intends to build
additional buildings. Based on 15A NCAC 02T .0114 Item (d), the average daily flow
would be
13 Acres x 880 gpd/acre = 11,440 gpd
As you can see from the preliminary subdivision plat, there is also an additional 465 acres
which this 12" 0 sewer extension will serve. Again, based on 15A NCAC 02T .0114
Item (d), the average daily flow would be
465 acres x 880 gpd/acre = 409,200 gpd
The required flow is575,675 gpd. The anticipated average daily flows would be
106,920 gpd + 55,200 gpd + 11,440 gpd + 409,200 gpd = 582,760 gpd
582,760 gpd > 575,675 gpd OK!
SEAL
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